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Rationale in the Single Session Treatment of Lung Tumors

Explore indications, treatment parameters, tracking methods, and results for lung tumor treatment in a single session, focusing on patient selection, tumor characteristics, and efficacy over 4 years.

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Rationale in the Single Session Treatment of Lung Tumors

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  1. Rationale in the Single Session Treatmentof Lung Tumors Markus Kufeld Christoph Fürweger, Christian Drexler Berndt Wowra, Alexander Muacevic

  2. Indication Treatment Tracking Results

  3. Indication patient selection Karnofsky Score > 60 diagnosis NSCLC Stage Ia - Ib metastases small targets (< 4 cm max. diameter) no central lesions

  4. Treatment Parameters target definition visible tumor volume (lung window) + 6 mm target volume 15 ccm median volume min 1,5 - max 129 ccm prescription 95% Conf. Int. 24 Gy median dose 22 - 24 70 % median isodose 70 - 75 Monte Carlo since June 2008 23 cases

  5. Tracking number of lesions 10 Xsight Spine fixed paraspinal lesions 54 Synchrony fiducial tracking 10 Xsight Lung live image quality 2 x switching to marker tracking

  6. Pt. 3577 Xsight Lung

  7. Tracking fiducial placement percutaneous, CT guided one marker in the lesion complications 6 pneumothorax 11 % 3 bleedings (asymptomatic) 6 % setup Xsight Spine setup -> translation to lesion

  8. Monte Carlo 39 ray tracing 23 Monte Carlo since June 2008 physically consistent dose prescription

  9. Results patients 62 patients in 4 years 27 female 65 yrs median age (min 22 - max 87 yrs) diagnosis 22 primary NSCLC 40 metastases follow up 11 months (median, min 0,5 - max 33 mths)

  10. Results actuarial local control Interval (mths) Failures Prop. Controlled 95% Conf. Int.0 - 6 1 98 % 89.1 99.8 6 - 12 4 88 % 74.1 95.1 18 - 24 0 88 % 74.1 95.1 crude local control 92 % => 3 re-treatments (controlled)

  11. Pt. 3864spinal tracking: tumor fixed to chest wall => missed target ?

  12. Graph Local Control Results

  13. Results failures ? tumor size contouring spinal tracking Xsight Lung unknown n.s.

  14. Graph Local Control Results

  15. Results adverse events after RS CTC Grade I 24 local pneumonitis (asymptomatic) CTC Grade II1 symptomatic pneumonitis (dyspnea, cough: medication) no CTC Grade III to V toxicity

  16. Pt. 1321 NSCLC 5 months post RS (24 Gy 70 %) pre RS pre RS

  17. Results n.s.

  18. Literature McGarry, Timmerman et al. (Red Journal 2005) Phase I dose escalation study: 3 fractions 20 Gy (80 % isodose) abdominal compression

  19. Literature Hof et al. (Cancer 2007) single session 15,2 - 24 Gy (80 % isodose) abdominal compression 14 % local failure 64 % pneumonitic CT changes (CTC I + II)

  20. Literature van der Voort van Zyp, Nuyttens et al. (Green Journal 2009) 3 fractions 15 -20 Gy (70 - 85 % isodose) multiple markers similar local control, overall survival similar toxicity

  21. Images Pt. 2273NSCLC control 15 months after RS

  22. Conclusion Single session lung radiosurgery is a safe and effective treatment option for selected small tumors.

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